Karel Kostev | IMS Health (original) (raw)

Papers by Karel Kostev

Research paper thumbnail of Adherence to GLP-1 receptor agonist therapy administered by once-daily or once-weekly injection in patients with type 2 diabetes in Germany

Diabetes, metabolic syndrome and obesity : targets and therapy, 2016

This study aimed to compare 6-month adherence to therapy with exenatide once weekly (Bydureon(®))... more This study aimed to compare 6-month adherence to therapy with exenatide once weekly (Bydureon(®)) vs liraglutide once daily (Victoza(®)) in patients with type 2 diabetes under primary care in Germany. A nationwide longitudinal prescription database (LRx), (between January 2011 and September 2014) was used to analyze adherence to therapy. The proportion of days covered (PDC) by prescription was used as a measure of adherence in the 6-month postindex period. Logistic regression analyses were performed to investigate the associations between glucagon-like peptide-1 receptor agonist therapy adjusting for age, sex, and cotherapy. Therapy was initiated in 5,449 patients with exenatide once weekly (age: 59.7±11.8 years; 51.4% were male) and in 24,648 patients with liraglutide once daily (age: 59.4±11.4 years; 49.7% were male). The median PDC was 0.88 for exenatide once weekly and 0.77 for liraglutide once daily (P<0.05). Once-weekly exenatide was associated with significantly higher adh...

Research paper thumbnail of Clinical and Patient-Related Variables Associated with Initiating GLP-1 Receptor Agonist Therapy in Type 2 Diabetes Patients in Primary Care in Germany

PLOS ONE, 2016

To investigate real-world clinical and patient-related variables associated with initiating GLP-1... more To investigate real-world clinical and patient-related variables associated with initiating GLP-1 receptor agonist (GLP-1RA) treatment relative to initiation of other glucose-lowering therapies in type 2 diabetes (T2D) patients of primary care in Germany. Data for 938 T2D patients who started therapy with a GLP-1RA within 823 practices of primary care throughout Germany were retrospectively analyzed (Disease Analyser: 01/2011-03/2014). 5,197 T2D patients who initiated other non-GLP-1RA antidiabetic therapies were selected as controls. Multivariate logistic regression analyses were applied to identify factors associated with GLP-1RA initiation in primary care. Mean age (SD) of GLP-1RA users was 57.8 (11.8) years (males: 55.5%) and the average BMI was 36.1 (6.7) kg/m2. 22.8% were in diabetologist care and 12.0% had private health insurance. In multivariate regression, choice of GLP-1RA therapy instead of a different glucose-lowering drug class was associated with obesity (odds ratio: 1.68; 95% CI: 1.34-2.10), private health insurance (2.42; 1.89-3.09), younger age (0.94; 0.93-0.95 per year), male sex (0.85; 0.73-0.99), diabetologist care (2.11; 1.73-2.57), and geographic practice location (East vs. West-Germany; 1.25; 1.05-1.49). Among co-medication, angiotensin II antagonists (increased) and non-steroidal antirheumatic agents (decreased) were related to GLP-1RA prescriptions (both p&amp;amp;lt;0.001). Consistent with German guidelines, GLP-1RA is mainly prescribed preferentially in T2D patients who are obese. GLP-1RA drugs were more frequently used than other options in privately health insured patients and in patients seeing a diabetologist.

Research paper thumbnail of Gender-based differences in the antidepressant treatment of patients with depression in German psychiatric practices

German medical science : GMS e-journal, 2016

Depression is recognized as the leading cause of disability in the world. Our goal was to compare... more Depression is recognized as the leading cause of disability in the world. Our goal was to compare treatment initiation in men and women treated in German neuropsychiatric practices after diagnosis of depression. Patients aged between 18 and 80 first diagnosed with depression between 2010 and 2013 were identified by 223 psychiatrists in the IMS Disease Analyzer database. Patients who had received antidepressant prescriptions prior to the index date were excluded. The main outcome measure was the initiation of antidepressant drug therapy in men and women within three years after index date in three subgroups of different severity (mild, moderate and severe depression). A total of 35,495 men and 54,467 women were included in this study. After 3 years of follow-up, 77.3% of men and 78.5% of women diagnosed with mild depression (p-value=0.887), 89.2% of men and 90.7% of women with moderate depression (p-value=0.084), and 88.6% of men and 89.5% of women with severe depression (p-value=0.7...

Research paper thumbnail of Prevalence of chronic diseases among older patients in German general practices

German medical science : GMS e-journal, 2016

To evaluate the prevalence of chronic diseases (CDs) among older patients in German general pract... more To evaluate the prevalence of chronic diseases (CDs) among older patients in German general practices (GPs). A total of 840,319 patients older than 65 years (359,289 male and 481,030 female) who consulted a GP between January and December 2014 were selected. Ten different CDs were considered: hypertension, lipid metabolism, diabetes, coronary heart disease, cancer, chronic obstructive pulmonary disease, heart failure, stroke, chronic kidney disease and osteoporosis. The prevalence, defined as the proportion of patients diagnosed with these disorders, was estimated. All CDs were very common in older subjects. Hypertension was the most common CD, affecting 65.7% of men and 66.1% of women. Stroke was the least frequent CD, with 6.6% of men and 5.1% of women displaying this condition. More than one out of two subjects had between one and three CDs (men: 57.7% and women: 59.3%). Approximately 25% of subjects had four or more CDs (men: 26.6% and women: 23.6%). Our study showed that the pr...

Research paper thumbnail of Age-related differences in persistence in women with breast cancer treated with tamoxifen or aromatase inhibitors in Germany

Journal of geriatric oncology, 2016

To study age-related persistence in postmenopausal women with endocrine-responsive breast cancer ... more To study age-related persistence in postmenopausal women with endocrine-responsive breast cancer treated with tamoxifen (TAM) and aromatase inhibitors (AI). Data on 29,245 patients diagnosed with metastatic or non-metastatic breast cancer (BC) and initially treated with TAM or AI between 2004 and 2013 were included. The primary outcome measure was the age-dependent rate of discontinuation of endocrine treatment within 5years after initiation. Discontinuation of therapy was defined as a period of at least 90days without treatment. A multivariate Cox regression model was created to determine the influence of age on the risk of discontinuation. Health insurance type (private/statutory), type of care (gynecological/general), region (West/East Germany), concomitant diagnoses (depression, osteoporosis, and diabetes), and Charlson Comorbidity Score were included as covariates. The mean ages of the women in the <70 and ≥70 groups were 55.9 (SD: 9.7) and 77.4 (SD: 5.4) years, respectively...

Research paper thumbnail of Entwicklungen in der Therapie von Gestationsdiabetes in diabetologischen Praxen in Deutschland: Retrospektive Datenbankanalyse

Research paper thumbnail of Cancer is associated with intraoperative and postprocedural complications and disorders

Journal of Cancer Research and Clinical Oncology, 2015

To analyze the impact of cancer on intraoperative and postprocedural complications (IPCs) in Germ... more To analyze the impact of cancer on intraoperative and postprocedural complications (IPCs) in Germany. Patients with first diagnosis of IPCs between 2010 and 2015 were identified in 982 general practitioners in the IMS Disease Analyzer database. Controls were included after individual matching (1:1) to IPC cases by age, gender, type of health insurance (private or statutory) and the physician. Demographic data included: age, sex and health insurance type (private or statutory). Clinical data included: cancer, diabetes, coronary heart disease including myocardial infarction, stroke including TIA, heart failure, chronic respiratory diseases, fractures and depression. A multivariate logistic model was used to calculate the risk of IPC on the basis of patient characteristics. A total of 5817 IPC patients and 5817 controls were included in this study. The mean age was 63.9 years, the proportion of people with private health insurance coverage was equal to 3.0 %, and the proportion of men was equal to 36.0 % in both groups; 21.5 % of IPC patients and 5.8 % of controls had cancer (p value &lt;0.0001). Moreover, diabetes, coronary heart disease, stroke, heart failure, chronic respiratory disease, fractures and depression were also significantly more common in IPC patients than in controls. Cancer had a negative impact on the risk of IPC (OR 4.27, 95 % CI 3.76-4.85 and p value &lt;0.0001). Coronary heart diseases, depression, fractures and chronic respiratory diseases were also significantly associated with an increased risk of IPC. The present study indicates that cancer increases the risk of IPCs and may reduce the clinical benefits of surgery.

Research paper thumbnail of Prevalence of diabetic foot disease in Germany

Research paper thumbnail of Starting an Insulin Therapy with Glargine Leads to Lower Long-Term Treatment Costs Compared to Detemir in German Type-2-Diabetics: Results of a Model

Research paper thumbnail of DDD vs. PDD: Berechnung von Tagestherapiekosten am Beipsiel von Liraglutid

Research paper thumbnail of Verbrauch und Kosten von Kortikoid-haltigen Nasensprays: ein Vergleich von Budesonid und Mometason Verordnungsdaten für Deutschland

Research paper thumbnail of Prevalence and characteristics of patient with pressure ulcer in German general practice

Research paper thumbnail of ET-Kongress 2015 Poster Konrad, Drosselmeyer, Jockwig, Kostev

Entwicklungsstörungen sind komplexe, neurobiologisch und genetisch bedingte Störungen, die sich b... more Entwicklungsstörungen sind komplexe, neurobiologisch und genetisch bedingte Störungen, die sich bereits in der frühen Kindheit manifestieren und bis ins Erwachsenenalter fortbestehen [1] . Eine der medizinisch orientierten Fördermaßnahmen stellt die Ergotherapie dar [2,3] . Ziel ist es, durch Betätigung in den Lebensbereichen Selbstversorgung, Produktivität und Freizeit, gestörte motorische, sensorische, psychische und kognitive Fähigkeiten zu verbessern [4] . In Deutschland wird die ambulante Ergotherapie von den niedergelassenen Ärzten verordnet, wonach die Ergotherapie in der ergotherapeutischen Praxis stattfindet [5] . Bei der Behandlung und ambulanten Versorgung von Kindern mit Entwicklungsstörungen sind vor allem die Kinderpsychiater zuständig [6,7] . Jedoch stehen diese, wie andere Ärzte, unter dem finanziellen Druck der Krankenkassen, sodass eine Verordnung immer begründet sein muss [8] . Das Ziel dieser Studie war es zu beurteilen, wie viele Patienten in einer bestimmten Patientengruppe in Deutschland nach der Diagnose von Entwicklungsstörungen eine ergotherapeutische Behandlung erhielten.

Research paper thumbnail of Ergotherapieverordnungen für Kinder mit Entwicklungsstörungen bei Kinderpsychiatern in Deutschland

Research paper thumbnail of Referral for occupational therapy after diagnosis of developmental disorder by German child psychiatrists

Early Child Development and Care, 2015

ABSTRACT

Research paper thumbnail of Erfüllen Hausärzte die Vorgaben der Leitlinien?

Research paper thumbnail of Persistence with antipsychotics in dementia patients in Germany


Int. Journal of Clinical Pharmacology and Therapeutics, 2016

Research paper thumbnail of Prevalence of depression in type 2 diabetes patients in German primary care practices

Journal of diabetes and its complications, 2016

To analyse depression in German type 2 diabetes patients with or without diabetes complications. ... more To analyse depression in German type 2 diabetes patients with or without diabetes complications. Longitudinal data from nationwide general practices in Germany (n=1,202) were analysed. People initially diagnosed with type 2 diabetes (2004-2013) were identified and 90,412 patients were included (age: 65.5 years, SD: 11.7). The main outcome measure was the first diagnosis of depression (ICD 10: F32, F33) within ten years after index date in patients with and without diabetes complications. Cox proportional hazards models were used to adjust for confounders. At baseline, most patients had diabetes complications and 6.4% of them had private insurance. Ten years after type 2 diabetes diagnosis, 30.3% of patients showed symptoms of depression. The prevalence of depression was higher in women than in men (33.7% versus 26.8%), in patients with high HbA1c levels (31.3% when Hb1Ac ≥ 9 versus 27.5% when HbA1c < 7) and in patients with diabetes complications (37.7% when there were more than ...

Research paper thumbnail of Impact of caesarean section on mode of delivery, pregnancy-induced and pregnancy-associated disorders, and complications in the subsequent pregnancy in Germany

German medical science : GMS e-journal, 2016

To analyze the impact of caesarean section (CS) on mode of delivery, pregnancy-induced and pregna... more To analyze the impact of caesarean section (CS) on mode of delivery, pregnancy-induced and pregnancy-associated disorders, as well as complications in the subsequent pregnancy within German gynecological practices. 1,801 women with CS and 1,801 matched women with vaginal delivery (VD) from the IMS Disease Analyzer database were included. The impact of previous CS on the mode of delivery and pregnancy-associated disorders as well as complications prior to or during birth in the subsequent pregnancy were analyzed. Cox regressions were used to determine the influence of CS with regard to these outcomes. Medical abortion and single spontaneous delivery were significantly less frequent in women with a history of CS compared to VD (OR equal to 0.52 and 0.04 respectively), whereas CS after CS was the significantly more common mode of delivery (79.0% versus 9.3%, OR=36.47). Gestational hypertension without significant proteinuria, gestational hypertension with significant proteinuria, and p...

Research paper thumbnail of Prescription Patterns and the Cost of Antihyperglycemic Drugs in Patients With Type 2 Diabetes Mellitus in Germany

Journal of Diabetes Science and Technology, 2016

The goals were to analyze prescription patterns and the cost of antihyperglycemic drugs in patien... more The goals were to analyze prescription patterns and the cost of antihyperglycemic drugs in patients with type 2 diabetes (T2DM) treated in Germany in 2015. This study included 36382 patients aged 40 years or over treated in general practices (GPs) and diabetologist practices who were diagnosed with T2DM in 2015. Nine different families of antihyperglycemic therapy were included in the analysis. Demographic data included age, gender, and type of health insurance coverage. Clinical data included HbA1c level, body mass index (BMI), and the number of T2DM complications. The annual antihyperglycemic treatment cost per patient was calculated based on pharmacy retail prices. The multivariate regression analysis was fitted to estimate the adjusted treatment cost differences. The percentage of T2DM patients receiving antihyperglycemic treatments was 87.6. This share was slightly higher in men than in women (89.1% vs 86.0%). Interestingly, the share of people treated with antihyperglycemic drugs decreased with age yet increased with HbA1c levels, BMI, and the number of complications. The average annual cost of antihyperglycemic drugs amounted to €498. It was significantly higher in men than in women (difference of €22). It was also significantly higher in individuals with private health insurance coverage than in people with public health insurance coverage (difference of €153). The annual cost decreased with age. It is compelling to note that this cost increased with HbA1c levels and BMI. Finally, the annual cost also increased with the number of complications. The share and the cost of antihyperglycemic treatments vary with gender, age, type of health insurance coverage, HbA1c levels, BMI, and the number of complications.

Research paper thumbnail of Adherence to GLP-1 receptor agonist therapy administered by once-daily or once-weekly injection in patients with type 2 diabetes in Germany

Diabetes, metabolic syndrome and obesity : targets and therapy, 2016

This study aimed to compare 6-month adherence to therapy with exenatide once weekly (Bydureon(®))... more This study aimed to compare 6-month adherence to therapy with exenatide once weekly (Bydureon(®)) vs liraglutide once daily (Victoza(®)) in patients with type 2 diabetes under primary care in Germany. A nationwide longitudinal prescription database (LRx), (between January 2011 and September 2014) was used to analyze adherence to therapy. The proportion of days covered (PDC) by prescription was used as a measure of adherence in the 6-month postindex period. Logistic regression analyses were performed to investigate the associations between glucagon-like peptide-1 receptor agonist therapy adjusting for age, sex, and cotherapy. Therapy was initiated in 5,449 patients with exenatide once weekly (age: 59.7±11.8 years; 51.4% were male) and in 24,648 patients with liraglutide once daily (age: 59.4±11.4 years; 49.7% were male). The median PDC was 0.88 for exenatide once weekly and 0.77 for liraglutide once daily (P<0.05). Once-weekly exenatide was associated with significantly higher adh...

Research paper thumbnail of Clinical and Patient-Related Variables Associated with Initiating GLP-1 Receptor Agonist Therapy in Type 2 Diabetes Patients in Primary Care in Germany

PLOS ONE, 2016

To investigate real-world clinical and patient-related variables associated with initiating GLP-1... more To investigate real-world clinical and patient-related variables associated with initiating GLP-1 receptor agonist (GLP-1RA) treatment relative to initiation of other glucose-lowering therapies in type 2 diabetes (T2D) patients of primary care in Germany. Data for 938 T2D patients who started therapy with a GLP-1RA within 823 practices of primary care throughout Germany were retrospectively analyzed (Disease Analyser: 01/2011-03/2014). 5,197 T2D patients who initiated other non-GLP-1RA antidiabetic therapies were selected as controls. Multivariate logistic regression analyses were applied to identify factors associated with GLP-1RA initiation in primary care. Mean age (SD) of GLP-1RA users was 57.8 (11.8) years (males: 55.5%) and the average BMI was 36.1 (6.7) kg/m2. 22.8% were in diabetologist care and 12.0% had private health insurance. In multivariate regression, choice of GLP-1RA therapy instead of a different glucose-lowering drug class was associated with obesity (odds ratio: 1.68; 95% CI: 1.34-2.10), private health insurance (2.42; 1.89-3.09), younger age (0.94; 0.93-0.95 per year), male sex (0.85; 0.73-0.99), diabetologist care (2.11; 1.73-2.57), and geographic practice location (East vs. West-Germany; 1.25; 1.05-1.49). Among co-medication, angiotensin II antagonists (increased) and non-steroidal antirheumatic agents (decreased) were related to GLP-1RA prescriptions (both p&amp;amp;lt;0.001). Consistent with German guidelines, GLP-1RA is mainly prescribed preferentially in T2D patients who are obese. GLP-1RA drugs were more frequently used than other options in privately health insured patients and in patients seeing a diabetologist.

Research paper thumbnail of Gender-based differences in the antidepressant treatment of patients with depression in German psychiatric practices

German medical science : GMS e-journal, 2016

Depression is recognized as the leading cause of disability in the world. Our goal was to compare... more Depression is recognized as the leading cause of disability in the world. Our goal was to compare treatment initiation in men and women treated in German neuropsychiatric practices after diagnosis of depression. Patients aged between 18 and 80 first diagnosed with depression between 2010 and 2013 were identified by 223 psychiatrists in the IMS Disease Analyzer database. Patients who had received antidepressant prescriptions prior to the index date were excluded. The main outcome measure was the initiation of antidepressant drug therapy in men and women within three years after index date in three subgroups of different severity (mild, moderate and severe depression). A total of 35,495 men and 54,467 women were included in this study. After 3 years of follow-up, 77.3% of men and 78.5% of women diagnosed with mild depression (p-value=0.887), 89.2% of men and 90.7% of women with moderate depression (p-value=0.084), and 88.6% of men and 89.5% of women with severe depression (p-value=0.7...

Research paper thumbnail of Prevalence of chronic diseases among older patients in German general practices

German medical science : GMS e-journal, 2016

To evaluate the prevalence of chronic diseases (CDs) among older patients in German general pract... more To evaluate the prevalence of chronic diseases (CDs) among older patients in German general practices (GPs). A total of 840,319 patients older than 65 years (359,289 male and 481,030 female) who consulted a GP between January and December 2014 were selected. Ten different CDs were considered: hypertension, lipid metabolism, diabetes, coronary heart disease, cancer, chronic obstructive pulmonary disease, heart failure, stroke, chronic kidney disease and osteoporosis. The prevalence, defined as the proportion of patients diagnosed with these disorders, was estimated. All CDs were very common in older subjects. Hypertension was the most common CD, affecting 65.7% of men and 66.1% of women. Stroke was the least frequent CD, with 6.6% of men and 5.1% of women displaying this condition. More than one out of two subjects had between one and three CDs (men: 57.7% and women: 59.3%). Approximately 25% of subjects had four or more CDs (men: 26.6% and women: 23.6%). Our study showed that the pr...

Research paper thumbnail of Age-related differences in persistence in women with breast cancer treated with tamoxifen or aromatase inhibitors in Germany

Journal of geriatric oncology, 2016

To study age-related persistence in postmenopausal women with endocrine-responsive breast cancer ... more To study age-related persistence in postmenopausal women with endocrine-responsive breast cancer treated with tamoxifen (TAM) and aromatase inhibitors (AI). Data on 29,245 patients diagnosed with metastatic or non-metastatic breast cancer (BC) and initially treated with TAM or AI between 2004 and 2013 were included. The primary outcome measure was the age-dependent rate of discontinuation of endocrine treatment within 5years after initiation. Discontinuation of therapy was defined as a period of at least 90days without treatment. A multivariate Cox regression model was created to determine the influence of age on the risk of discontinuation. Health insurance type (private/statutory), type of care (gynecological/general), region (West/East Germany), concomitant diagnoses (depression, osteoporosis, and diabetes), and Charlson Comorbidity Score were included as covariates. The mean ages of the women in the <70 and ≥70 groups were 55.9 (SD: 9.7) and 77.4 (SD: 5.4) years, respectively...

Research paper thumbnail of Entwicklungen in der Therapie von Gestationsdiabetes in diabetologischen Praxen in Deutschland: Retrospektive Datenbankanalyse

Research paper thumbnail of Cancer is associated with intraoperative and postprocedural complications and disorders

Journal of Cancer Research and Clinical Oncology, 2015

To analyze the impact of cancer on intraoperative and postprocedural complications (IPCs) in Germ... more To analyze the impact of cancer on intraoperative and postprocedural complications (IPCs) in Germany. Patients with first diagnosis of IPCs between 2010 and 2015 were identified in 982 general practitioners in the IMS Disease Analyzer database. Controls were included after individual matching (1:1) to IPC cases by age, gender, type of health insurance (private or statutory) and the physician. Demographic data included: age, sex and health insurance type (private or statutory). Clinical data included: cancer, diabetes, coronary heart disease including myocardial infarction, stroke including TIA, heart failure, chronic respiratory diseases, fractures and depression. A multivariate logistic model was used to calculate the risk of IPC on the basis of patient characteristics. A total of 5817 IPC patients and 5817 controls were included in this study. The mean age was 63.9 years, the proportion of people with private health insurance coverage was equal to 3.0 %, and the proportion of men was equal to 36.0 % in both groups; 21.5 % of IPC patients and 5.8 % of controls had cancer (p value &lt;0.0001). Moreover, diabetes, coronary heart disease, stroke, heart failure, chronic respiratory disease, fractures and depression were also significantly more common in IPC patients than in controls. Cancer had a negative impact on the risk of IPC (OR 4.27, 95 % CI 3.76-4.85 and p value &lt;0.0001). Coronary heart diseases, depression, fractures and chronic respiratory diseases were also significantly associated with an increased risk of IPC. The present study indicates that cancer increases the risk of IPCs and may reduce the clinical benefits of surgery.

Research paper thumbnail of Prevalence of diabetic foot disease in Germany

Research paper thumbnail of Starting an Insulin Therapy with Glargine Leads to Lower Long-Term Treatment Costs Compared to Detemir in German Type-2-Diabetics: Results of a Model

Research paper thumbnail of DDD vs. PDD: Berechnung von Tagestherapiekosten am Beipsiel von Liraglutid

Research paper thumbnail of Verbrauch und Kosten von Kortikoid-haltigen Nasensprays: ein Vergleich von Budesonid und Mometason Verordnungsdaten für Deutschland

Research paper thumbnail of Prevalence and characteristics of patient with pressure ulcer in German general practice

Research paper thumbnail of ET-Kongress 2015 Poster Konrad, Drosselmeyer, Jockwig, Kostev

Entwicklungsstörungen sind komplexe, neurobiologisch und genetisch bedingte Störungen, die sich b... more Entwicklungsstörungen sind komplexe, neurobiologisch und genetisch bedingte Störungen, die sich bereits in der frühen Kindheit manifestieren und bis ins Erwachsenenalter fortbestehen [1] . Eine der medizinisch orientierten Fördermaßnahmen stellt die Ergotherapie dar [2,3] . Ziel ist es, durch Betätigung in den Lebensbereichen Selbstversorgung, Produktivität und Freizeit, gestörte motorische, sensorische, psychische und kognitive Fähigkeiten zu verbessern [4] . In Deutschland wird die ambulante Ergotherapie von den niedergelassenen Ärzten verordnet, wonach die Ergotherapie in der ergotherapeutischen Praxis stattfindet [5] . Bei der Behandlung und ambulanten Versorgung von Kindern mit Entwicklungsstörungen sind vor allem die Kinderpsychiater zuständig [6,7] . Jedoch stehen diese, wie andere Ärzte, unter dem finanziellen Druck der Krankenkassen, sodass eine Verordnung immer begründet sein muss [8] . Das Ziel dieser Studie war es zu beurteilen, wie viele Patienten in einer bestimmten Patientengruppe in Deutschland nach der Diagnose von Entwicklungsstörungen eine ergotherapeutische Behandlung erhielten.

Research paper thumbnail of Ergotherapieverordnungen für Kinder mit Entwicklungsstörungen bei Kinderpsychiatern in Deutschland

Research paper thumbnail of Referral for occupational therapy after diagnosis of developmental disorder by German child psychiatrists

Early Child Development and Care, 2015

ABSTRACT

Research paper thumbnail of Erfüllen Hausärzte die Vorgaben der Leitlinien?

Research paper thumbnail of Persistence with antipsychotics in dementia patients in Germany


Int. Journal of Clinical Pharmacology and Therapeutics, 2016

Research paper thumbnail of Prevalence of depression in type 2 diabetes patients in German primary care practices

Journal of diabetes and its complications, 2016

To analyse depression in German type 2 diabetes patients with or without diabetes complications. ... more To analyse depression in German type 2 diabetes patients with or without diabetes complications. Longitudinal data from nationwide general practices in Germany (n=1,202) were analysed. People initially diagnosed with type 2 diabetes (2004-2013) were identified and 90,412 patients were included (age: 65.5 years, SD: 11.7). The main outcome measure was the first diagnosis of depression (ICD 10: F32, F33) within ten years after index date in patients with and without diabetes complications. Cox proportional hazards models were used to adjust for confounders. At baseline, most patients had diabetes complications and 6.4% of them had private insurance. Ten years after type 2 diabetes diagnosis, 30.3% of patients showed symptoms of depression. The prevalence of depression was higher in women than in men (33.7% versus 26.8%), in patients with high HbA1c levels (31.3% when Hb1Ac ≥ 9 versus 27.5% when HbA1c < 7) and in patients with diabetes complications (37.7% when there were more than ...

Research paper thumbnail of Impact of caesarean section on mode of delivery, pregnancy-induced and pregnancy-associated disorders, and complications in the subsequent pregnancy in Germany

German medical science : GMS e-journal, 2016

To analyze the impact of caesarean section (CS) on mode of delivery, pregnancy-induced and pregna... more To analyze the impact of caesarean section (CS) on mode of delivery, pregnancy-induced and pregnancy-associated disorders, as well as complications in the subsequent pregnancy within German gynecological practices. 1,801 women with CS and 1,801 matched women with vaginal delivery (VD) from the IMS Disease Analyzer database were included. The impact of previous CS on the mode of delivery and pregnancy-associated disorders as well as complications prior to or during birth in the subsequent pregnancy were analyzed. Cox regressions were used to determine the influence of CS with regard to these outcomes. Medical abortion and single spontaneous delivery were significantly less frequent in women with a history of CS compared to VD (OR equal to 0.52 and 0.04 respectively), whereas CS after CS was the significantly more common mode of delivery (79.0% versus 9.3%, OR=36.47). Gestational hypertension without significant proteinuria, gestational hypertension with significant proteinuria, and p...

Research paper thumbnail of Prescription Patterns and the Cost of Antihyperglycemic Drugs in Patients With Type 2 Diabetes Mellitus in Germany

Journal of Diabetes Science and Technology, 2016

The goals were to analyze prescription patterns and the cost of antihyperglycemic drugs in patien... more The goals were to analyze prescription patterns and the cost of antihyperglycemic drugs in patients with type 2 diabetes (T2DM) treated in Germany in 2015. This study included 36382 patients aged 40 years or over treated in general practices (GPs) and diabetologist practices who were diagnosed with T2DM in 2015. Nine different families of antihyperglycemic therapy were included in the analysis. Demographic data included age, gender, and type of health insurance coverage. Clinical data included HbA1c level, body mass index (BMI), and the number of T2DM complications. The annual antihyperglycemic treatment cost per patient was calculated based on pharmacy retail prices. The multivariate regression analysis was fitted to estimate the adjusted treatment cost differences. The percentage of T2DM patients receiving antihyperglycemic treatments was 87.6. This share was slightly higher in men than in women (89.1% vs 86.0%). Interestingly, the share of people treated with antihyperglycemic drugs decreased with age yet increased with HbA1c levels, BMI, and the number of complications. The average annual cost of antihyperglycemic drugs amounted to €498. It was significantly higher in men than in women (difference of €22). It was also significantly higher in individuals with private health insurance coverage than in people with public health insurance coverage (difference of €153). The annual cost decreased with age. It is compelling to note that this cost increased with HbA1c levels and BMI. Finally, the annual cost also increased with the number of complications. The share and the cost of antihyperglycemic treatments vary with gender, age, type of health insurance coverage, HbA1c levels, BMI, and the number of complications.